Womens Health

State Licensing Midwives: Necessary or Exploitive?

| by Unnecesarean

I shared a status update from The Big Push for Midwives Campaign on our Facebook page:

Via The Big Push for Midwives Campaign: ” So, we’re getting good news from Mississippi, North Carolina, Iowa, Ohio, Indiana, South Dakota, Colorado, Nebraska, Michigan — our PushMap is just gonna get bluer and bluer (in a good way!) this year. Keep sharing stories from your statehouse adventures, Pushers!”

 

Here are the 151 comments that followed:

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The Unnecesarean

That’s not without a TON of grassroots/ legal work that nobody ever sees. Keep it up and thank you!

Sunday at 7:57am

 

Jen

I hope Michigan stays like it is. All midwives are free to practice here. Changing the laws will add more rules and regulations I fear.

Sunday at 8:02am

 

Sabrina S.

Illinois needs to change its ways. We are underground here, but still home-birthing with midwives!http://scrambledmommybrain.blogspot.com/2011/01/james-sullivan-peschkes-...

Sunday at 8:06am

 

Katherine M.

TBP is not a good thing. It’s going to hurt more women than it will ever help.

Sunday at 8:06am

 

Katie B.

I have VERY mixed feelings about TBP—I don’t think it’s cut and dried in either direction. :/

Sunday at 8:09am

 

Laurel

What are Louisiana laws on mid-wives?

Sunday at 8:11am

 

Jen

Laurel, you can go to mana.org and find your state. Looks like they license CPMs there.

Sunday at 8:15am

 

Katie S.

Laurel- they do, but the state is making it very hard to continue practicing for all but a few midwives. It’s almost as crooked as the rest of the state :(.

Sunday at 8:40am

 

J

Those of you on this thread who don’t want regulation- just stick with your midwife. She doesn’t have to get licensed she can stay underground and you all can enjoy all the benefits of an unregulated health care provider: infection, dangerous practice and unscrupulous behavior. I also suggest you start seeing unlicensed dentists, and surgeons too since you’re into unregulated health care providers.

Sunday at 9:08am

 

Rebecca

Jen, as far as I know there is no law in Michigan allowing all midwives to practice. Until there is, it is only a matter of time until someone gets prosecuted for practicing medicine or nursing without a license. If I’m wrong about this, please cite the law you’re referring to and I will gladly eat my hat!

Sunday at 9:21am

 

Julie ‎

@J- So you’ve seen an unregulated HCP? Can you tell us your experience please?

Sunday at 9:22am

 

Jen

Having letters after your name doesn’t make you good at what you do. When you choose someone to care for you, you do research and find one that fits. Unscrupulous behavior? Really? Infection? It sounds like you are coming from a place of hate and ignorance.

Sunday at 9:24am

 

Katherine M.

[email protected] - amazing. None of the underground midwives I and my friends know have any of those problems you mentioned. However, the LICENSED ones do, and they also have a very high (for midwives) c-section rate, induction rate, no informed consent rate and “risk out” rate. Yeah, I’ll stay with my underground midwife thanks. If I hadn’t had her, I never would have been able to have my HWBAC. Unlicensed does NOT mean uneducated. I’d bet my life (and obviously did) that my midwife has MORE education and MORE experience than the licensed ones in my state, k thanks.

Sunday at 9:28am

 

Jen

This feels like a witch hunt all over again. *sigh*

And yes, midwives are free to practice here in Michigan. The only law states that you can not practice medicine without a license. Since WE ALL KNOW that birth is a natural event and most don’t require intervention and medication, we can provide women with this care. We do not (by definition) care for high risk moms.

Didn’t doctors try to irradicate midwives 200 years ago with these SAME tactics? Talking about unscrupulous behaviors and infection? Watch out lades… it’s a witch hunt.

Sunday at 9:37am

 

The Unnecesarean

A consumer-driven witch hunt? Interesting construct.

Sunday at 9:49am

 

Rebecca

And by “we all” do you mean prosecutors? Because they’re the ones who arrest midwives and charge them for practicing without a license. That midwifery is not the practice of medicine (or nursing) is not a given in state law, unless specifically carved out. I’m not saying I disagree with you, but that argument does not hold up in court.

For those interested in learning more about the myths related to “alegal” midwifery practice, please read this:http://fromcallingtocourtroom.net/

Sunday at 9:53am

 

Katherine M.

The witch hunt is going to come from midwives turning in other midwives because they’re not licensed yadda. The whole thing is midwives attempting to “fit in” to a medical system when they shouldn’t be IN the system at all. Pregnancy is, most of the time, NOT a medical issue. When there IS a medical issue, then go to an obstetrician. That’s what they should be there for. Otherwise, keep birth unmedical and OUT of the system!

Sunday at 9:54am

 

Jen

I disagree. I believe that it is driven by those working as “midwives with degrees.” If it wasn’t, why aren’t ALL midwives included instead of just CPMs?

Sunday at 9:55am

 

Steff Hedenkamp

Stay underground by all means. But do recognize with eyes wide open the paradigm in which we currently co-exist in the US is one that calls for licensure/regulation of health-care providers. Midwives do not stand as some special group for whom regulation somehow does not apply. Opt out if you must, stay down down deep underground, but don’t fight the rights of moms and families who want their state to join the 21st century, bring midwifery up from behind the cloak and dagger, so they can have the ability to find their midwife in the yellow pages, to ensure she has the qualifications they want, backed up by a license from the state. Seriously, stay underground by all means, but stop trying to pretend that licensure is something you can shout down with comparisons to the shameful acts of obs to annihilate an entire profession 100 yrs ago. Remember that we have to INTEGRATE midwives into our states’ maternity-care systems, and that WILL NOT happen without licensure.

 

Jen

So let me get this straight Steff. You’re trying to protect ME by making me and other traditional midwives conform to YOUR rules. I don’t see any legislature working on this by themselves so it’s your push, right? Your agenda? The PUSH towards being able to advertise in the phone book?

We ABSOLUTELY ARE a special group. Because we DO NOT PROVIDE medical care. We provide holistic care to moms who are low risk. I agree with Katherine. This is going to be a witch hunt that comes from within… those who want to PUSH OUT traditional midwives.

Sunday at 10:42am

 

Rebecca

No, I don’t think Steff said that anyone is trying to force traditional midwives to become CPMs or to get licensed. Some just want to make licensed midwifery among the options that families can choose. This does not mean that traditional midwives can’t continue to practice outside of the system and outside of the law, if that’s what they and the women they serve prefer.

Sunday at 11:19am

 

Jen

But that’s exactly what you’re doing. In Michigan, we are ALL legal as long as we are not practicing medicine. Essentially you will make us ALL ILLEGAL with your push. So yes, it’s either join you or get arrested. Does that sum it up?

Sunday at 11:24am

 

Katherine Hemple Prown

The case law on this issue is settled, which is why we no longer hear about midwives being prosecuted for practicing medicine without a license. Almost all cases now end in plea bargains since no attorney in their right mind would recommend going to trial because the courts have consistently found that, in the absence of a law defining the practice of DEM, exempting it from the medical and nursing practice acts and providing for regulation under civil administrative law—as opposed to criminal law, which otherwise applies—DEMs are practicing medicine and/or nursing without a license, which in most states are felonies.

That’s simply for routine maternity care and births. In the event of a death or injury, DEMs in states without licensure are also subject to prosecution for involuntary manslaughter or reckless endangerment, and those who carry or use Pitocin and similar meds are subject to additional charges of the unauthorized possession or use of prescription medications.

The medical practice acts in all 50 states were intentionally written—and aggressively promoted by the medical lobby—with the specific purpose of defining all types of health care as the practice of medicine, with the intent of giving allopathic providers a monopoly and making everyone else, not just midwives, but homeopaths, naturopaths, bonesetters, and a whole range of traditional practitioners, illegal.

The only professions that survived the AMA’s campaign to carve out a monopoly for themselves were those, like chiropractors, for example, that successfully passed exemptions to state medical practice acts and lobbied for regulation under civil—as opposed to criminal—law via licensure. Other professions were driven underground, marginalized out of existence, and/or subject to ongoing harassment and criminal prosecution.

And it’s not just unlicensed providers who are subject to harassment and prosecution, but a disturbing new trend involves home birth parents losing custody of their babies for giving birth with unlicensed midwives. There have been four cases in the last year alone that I’m aware of, one of them involving a state legislator whose wife had a home birth.

This is just one among many reasons why the Big Push is a consumer-driven campaign, not a midwife-led campaign. Many of us (including me) have personal experiences with our midwives being prosecuted in unlicensed states and watching their numbers dwindle to the point where our only choice remains to have a UC or give birth in another state.

Sunday at 11:43am

 

Rebecca

As I’ve been trying to say, “As long as we are not practicing medicine” is valid so long as the prosecuting attorney agrees with your definition- which could be forever, or you could get arrested tomorrow. ALL CAPS indignation notwithstanding. Do you carry pit or oxygen? Who defines “low risk”? What happens when you transport to hospital or transfer to an OB? What happens if there is a bad outcome?

I understand the desire not to rock the boat if things have been going well for a while in your state. But look around, at Illinois and Ohio, for example, which have both seen home birth families charged for using unlicensed midwives, and even lost custody of their babies (in IL regained it later).

I respect your position, but I disagree as a citizen working for better government that the status quo is acceptable. And as an attorney (licensed to practice my profession), I can tell you that your assessment of your legal status is dangerously incorrect.

Sunday at 11:46am

 

Katherine M.

Who is responsible for the midwives being prosecuted? i.e. WHY are they prosecuted to begin with?

Sunday at 11:49am

 

Katherine Hemple Prown

Most prosecutions—as well as investigations and cease and desist orders from state agencies—are generated by complaints from hospital personnel in the aftermath of a transport. Of those, a significant number, if not the majority, involve appropriate transports that ended with a healthy mother and a healthy baby.

Sunday at 12:00pm

 

Jen

So licensure will make you invincible from getting sued and miraculously make it so parents won’t get their kids taken from them? It’s worked so far for OB doctors, right? I’ve read where a mom refused antibiotics and immunisations and get CPS called on them. There is no such thing as a magical letters that prevent people from suing you or calling Child Welfare.

Sunday at 12:37pm

 

Rebecca

Sued? No, no one is invincible from getting sued. We’re talking about midwives and families being criminally prosecuted, which is different. When you get sued, it is by a private party such as a family who was harmed by the negligence of a midwife. The penalty for getting sued and losing is having to pay money. Prosecution means being charged with a crime. The penalty for being found guilty of a crime can include jail.

So while OBs get sued for negligence, or even just for bad outcomes, they almost never get charged with a crime like manslaughter or reckless endangerment (though I’m sure some folks think they should be).

No doubt that child protective laws are increasingly being used in a punitive fashion against women who make their own decisions in maternity care, in or outside of the hospital. This is unacceptable but in no way made better by midwives remaining unlicensed.

Sunday at 1:18pm

 

Katherine Hemple Prown

Getting sued and being criminally prosecuted are two different things. Anyone can be sued for many different reasons, but only people who have been accused of breaking the law can be criminally prosecuted and face prison time for it. Unlicensed midwives in every state are breaking the law and are subject to criminal prosecution as a result.

In states that offer licensure, unlicensed midwives face the lesser misdemeanor charge of practicing midwifery without a license, as opposed to states without midwifery licensure, where the charges would be the felony practice of medicine and/or nursing without a license.

In every state you are required to hold a license in order to perform the acts that midwives routinely engage in during the course of their work. The issue isn’t whether you need to have a license to practice legally but which professional licenses are available in your state in order for you to practice in accordance with the law.

The truth is, however, that states that offer midwifery licensure rarely prosecute unlicensed midwives because the assumption is that when licensure becomes available, everyone will get it. It really doesn’t occur to most people that members of a profession would hold philosophical objections to licensure and choose to practice without it.

The parents who lost custody of their children after a home birth were charged with endangering them by hiring an unlicensed provider to attend the birth, not by giving birth at home. I have yet to hear of a case where parents were charged with endangerment for choosing to give birth at home with a licensed provider.

Sunday at 1:24pm

 

Jen

Lots of great scare tactics ladies. Bravo. We have everything from infection, unscrupulous behavior, dangerous practices, criminal prosecution, our clients risking custody of their children and a threat to stay underground “or else.” Sounds like a true dictatorship. Lots of “this is for your own good” talk. We have all seen what happens in hospitals when “committees,” insurance groups and ACOG start telling the masses how to practice. What happened to autonomy? What happens to women’s choices when the “committee” deems breech and twins high risk? All this possible loss just to be able to put your name in a phonebook and the ability to bill insurance companies? Tsk Tsk. No thanks. Perhaps you should learn how to just breathe and not push. Pushing is for bullies.

Sunday at 2:14pm

 

Renee

I am in Michigan, and I had a homebirth with a licensed CPM. I know CNM’s can also practice in the hospital, birth centers and in the home in Michigan as well. I’m confused as to what is meant by no laws in Michigan allowing midwives to practice? Are we talking about reimbursement? Ability to be insured? I do need to read a little more up on this, and will do so tonight… but just wondering if I could have clarification as to what is meant by this comment.

Sunday at 2:15pm

 

Renee

My CPM does have pitocin, cytotec, oxygen, self inflating bag and masks. I had a hospital available for back up and an OB available for back up.

I do wonder why CNM’s and CPM’s are fighting. Midwifery experienced a great amount of back lash and hatred from OB’s @ the turn of the 20th century. We are still suffering for it. We need to not fight, but know that we both have the same end goal, the same passion for the normal progression of pregnancy/labor/birth. If we ALL (CNM’s, CPM’s, CM’s, etc and OB’s) work in collaboration, we can decrease the cesarean rate, induction rate, vac/forcep rate… and promote a happy, healthy outcome for all moms and babies.

Sunday at 2:23pm

 

The Unnecesarean

Jen B. wrote: “What happened to autonomy?”

Where in this thread is anyone trying to say that women must give birth with a certain kind of care provider? Steff clearly wrote that those who wish to remain underground can remain underground and maintain the status quo if they choose to. I, too, support every woman’s right to give birth with the midwife or doctor (or neither) of her choice.

This is a consumer-driven effort to license and regulate midwives, so it’s just bizarre to me that you see it as a bullying dictatorship. How specifically will your practice change if the state has licensure? Will you not still attend the births of clients who think you’re the best birth attendant for them? Will you lose income? I’m not getting why it would matter to you if you choose to remain unlicensed, so maybe you can clear that up for me.

Sunday at 2:39pm

 

Melanie

I wish midwives were easier to get in Ontario… There seems to be a severe shortage here…

Sunday at 2:48pm

 

Jen

Jill, as Rebecca wrote: “This does not mean that traditional midwives can’t continue to practice outside of the system and outside of the law, if that’s what they and the women they serve prefer.” I don’t work outside of the law and I am not “underground.” Apparently this will change if the push goes through. THIS is how my practice will change. I hope that’s clear. Unlicensed = unlawful.

Income? Pfft. I didn’t become a midwife to get rich.

Sunday at 2:49pm

 

Janet

Can I ask what the licensed mws sought by the Big Push can offer in terms of HBAC and HBAMC? Regulation seldom results in women with scars being supported to birth at home so I would like to hear how midwives are making sure all women are able to access their services. Thanks. : )

Sunday at 2:59pm

 

Katherine Hemple Prown

Unlicensed midwives in Michigan aren’t practicing outside of the law, they’re practicing in violation of it. Whether that law is currently enforced is another question, but it’s a law that is identical to those in multiple other states that have been used to convict midwives of practicing medicine and/or nursing without a license.

Sunday at 3:07pm

 

Jen

Can you please tell me how I am violating the law.

Sunday at 3:20pm

 

The Unnecesarean

Katie, thanks. OK, so Michigan midwives are all currently practicing in violation of the law. With the licensure option, some will have the option to practice in within the law (pardon my non-lawyer explanation), but they might have to make concessions (like no VBAC) to do so. Others, like you, Jen, will not get licensed, presumably, and can remain as you currently are in violation of the law. The question I have is how things will change for you if you remain the same.

Sunday at 3:25pm

 

Rebecca

Michigan law defines:

(a) “Practice of nursing” means the systematic application of substantial specialized knowledge and skill, derived from the biological, physical, and behavioral sciences, to the care, treatment, counsel, and health teaching of individuals who are experiencing changes in the normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury, or disability.

(d) “Practice of medicine” means the diagnosis, treatment, prevention, cure, or relieving of a human disease, ailment, defect, complaint, or other physical or mental condition, by attendance, advice, device, diagnostic test, or other means, or offering, undertaking, attempting to do, or holding oneself out as able to do, any of these acts.

Do any of these things? Take heart tones? Carry pit or oxygen? You’re breaking the law. Full stop.

Jill- we’ve seen states gain licensure without the restrictions you suggest, for example Virginia.

Sunday at 3:34pm

 

Tuesday

Ohio is all set to push a bill through that will make all midwives not liscensed unlawful…in a state that put a midwife on probation but ALLOWED her to continue to practice, that has midwives registered to sign birth certificate info…i fail to see how clearly making non-licensed midwives unlawful benifits any but the select midwives who want this. over and over i talk with misinformed consumers who have spoken with midwives who assure them this bill will make midwives legal, without informing them that it will make a lot of us unlawful.

Sunday at 3:47pm

 

Jen

Is this for real? I “treat” my son’s “ailment” and “complaint” of a skinned kneed by the “device” of a band-aid and “advise” him to tie his shoes. Apparently we’re all guilty. QUICK mothers…get your parenting license in order to treat your children or you’ll be in violation or Michigan’s laws. *rolling my eyes*

Sunday at 3:50pm

 

Jen

P.S. Because of an attorney general’s decision in 1939 that midwifery was not the practice of medicine, midwifery is still legal to practice in Michigan.

Sunday at 3:52pm

 

The Unnecesarean

Janet, it sounds like in some states depending on the bill, nothing changes for VBAC moms, where as women without scars can access the services of a licensed midwife. I think where I get lost in some of the rhetoric (not in this thread) is whether people are arguing for all women, including those with previous c/s to be able to work with the licensed midwife of their choosing (out of fairness, it seems) or whether they’re arguing for no licensing at all because they believe that licensing midwives takes away the choice to VBAC at home (if that’s what the bill stipulates).

I *think* a lot of the complaints about the IL bill were the former… that it’s not fair for the option to work with a licensed midwife to be extended to some and not all, particularly in light of the fact that the c/s rate is over the top. This argument is based on the belief that licensure is something desirable to which all women should have access, not just some.

The other criticism was just that licensing shouldn’t happen because _____.

It sounds like you’re in the first camp… licensing is good as long as all women have access to a licensed midwife. Otherwise, it’s unfair. Is that right?

Sunday at 3:54pm

 

The Unnecesarean

Tuesday, you just explained what I was trying to figure out. So the wording of the Ohio bill doesn’t just license those who wish to be licensed, it also explicitly states that all non-licensed midwives are “unlawful”?

Sunday at 3:58pm

 

Janet

Our current maternity services are all run by people who are licensed and regulated in some way. Nurses, hospital midwives, doctors, all licensed and regulated. We perceive that system to be broken and somehow we think that extending that licensing and regulating will then serve women’s needs?

Sunday at 4:10pm

 

Rebecca

Jill, states are not keen on so-called “voluntary licensure,” whereby only the professionals who feel like it get licensed and the others are free to practice legally. It doesn’t fly for doctors, dentists, plumbers, or barbers. Midwives aren’t exempt from this general structure & function of public health law. I’m not trying to be a jerk here- states have the power to regulate professions and to exclude unregulated practitioners (via the 10th amendment).

Jen, yes the sections of the law I cited are real. The difference between the example with your own child and the example of midwifery practice is that midwives hold themselves out as providing these services to the general public in exchange for money (though the money part doesn’t matter that much).

It sounds like folks are banking on a decades old AG’s opinion (not a law, an interpretation of the then-current law and practice) and/or the fact that midwives can sign birth certificates without being sent a cease and desist? If I’m a lawyer defending with that, I’d say beg for a plea bargain and move to another state where you can get yourself a license.

Sunday at 4:11pm

 

Jen

It sounds like CPMs aren’t so keen on voluntary licensure. Because, why would anyone get certified if there is no law governing it. You NEED a law governing it, regulating it for your CPM “status” to mean anything. I give my statistics out to my clients. I also tell them in writing and verbally that I am not practicing medicine, I don’t diagnose any conditions nor do I carry any drugs or anything requiring a prescription. I am upfront about everything. You are single-handedly making it UNLAWFUL for 1/2 of the midwives in this country to practice what they love. Maybe someone else should start a group against the push.

Sunday at 4:23pm

 

The Unnecesarean

‎”You are single-handedly making it UNLAWFUL for 1/2 of the midwives in this country to practice what they love.”

Where does the 1/2 figure come in?

I’m still not getting how licensing those who wish to be licensed makes those who do not “unlawful.” Is it written into the bill?

Jen, what would the anti-Big Push group advocate for?

 

Katherine Hemple Prown

Family members are exempt from the medical and nursing practice acts in every state, otherwise parents everywhere would be subject to prosecution!

However, non-family members who provide the same services to other people, ranging from recommending dietary changes to taking temperatures, are not exempt from medical and nursing practice acts. If they engage in the activities enumerated in those laws and they do not hold a license to practice medicine or nursing, then they’re breaking the law, period.

FYI, the MI AG’s Opinion predates the current medical practice act and has been void since the late 1970s.

Sunday at 4:48pm

 

Jen

Jill, I just came up with 1/2. There are many DEMs working right now. And it is impossible to know the exact number. However, if the laws come to our states where it isn’t regulated, DEMS would become illegal. I don’t know how else to put it. It is NOT unlawful for a DEM, traditional midwife or lay midwife to practice in Michigan. We are not in violation of any laws. If a midwife carries pitocin, yes, she is in violation of the law because legally midwives in Michigan can not carry prescription drugs nor administer them. If the big push comes to michigan, ONLY CPMs will be legal. CNMs are nurses and are already governed. DEM, TM, Lay Midwives would BECOME illegal because they are not included in the bills. Therefore, the forementioned midwives must BECOME CPMs in order to practice legally. The bills do NOT encompass all midwives. Just the “select” group of CPMs throwing all others who were previous legal would then become illegal. I hope that was clear. I don’t know how else to say it.

Sunday at 4:52pm

 

Susan M. Jenkins

Let’s clarify a few points here:

Jen, in Michigan, you are not practicing within the law, you are presenting in violation of the medical practice act and/or nursing practice act, as Rebecca explained. Rebecca is an attorney. She just took and passed the bar exam. Do all of you believe that Rebecca or I should be permitted to practice law without a license, just because we act in good faith and believe we know what we are doing?

What about your baby’s pediatrician, folks? Should she or he be allowed to practice without a license because she or he loves babies and trusts mothers?

Unlicensed midwives in Michigan have been fortunate for many years because the enforcement mechanism has had some quirks that resulted in a reluctance to prosecute on behalf of the state powers that be. A bill has been introduced already, NOT by the Big Push or any Michigan midwife or consumer group, by by the State government, that would fix that mechanism. The Michigan State Medical Society began talking talking about cracking down on unlicensed midwives a few years ago. It is only a matter of time until someone gets arrested.

In Ohio, in 2007, two midwives were arrested. Arrested. The home of one, where her office was located, was searched and her computer and all her client records were taken. The prosecutor wanted her computer so he could track down other midwives. That was 3 1/2 years ago. I talked to the midwives it happened to. They had to hire lawyers to fight criminal charges.

The Ohio bill you mention simply substitutes “unlawful practice of midwifery” for “unlawful practice of medicine,” which means it’s an improvement in the situation for unlicensed midwives, not a step backwards.

The Big Push isn’t about really about protecting midwives or protecting CPMs — it’s a consumer/midwife movement to protect consumers. Those consumers who don’t want to use a regulated midwife are free to find unlicensed unregulated midwives who continue to practice in violation of the law.

Jill, thanks for posting our status report and hosting this discussion. It is by no means the case that HBAC will be lost just because a licensure/regulation law is passed. The Big Push wants to work with VBACtivists so that all parties are at the table when the Medical Society raises this issue or legislators ask about VBAC. ICAN members can help out state groups answer the questions that legislators might have about home VBAC.

Sunday at 5:10pm

 

J

‎@ Jen: So this is all included in the informed consent you give your clients correct? You don’t carry pitocin, would that also extend to methergine in the case of a pph? Can you explain to me and anyone else here wondering how you handle that without lawful recognition to carry that life saving medication?what do you do just explain the legality of your practice to them instead?

Sunday at 5:10pm

 

Jen

‎”I have never for one second understood the rationale of licensing midwives for it is THE TROJAN HORSE. If we buy into the idea that midwives need to be regulated or licensed we not only are saying that midwives can be dangerous and SOMEBODY (guess who?) needs to watch them…..BUT WE ARE SAYING THAT BIRTH IS DANGEROUS AND THAT SOMEBODY OTHER THAN THE MOTHER NEEDS TO BE IN CHARGE!” ~ Carla Hartly

“Midwifery needs strong, outspoken, autonomous women to articulate a vision of birth with dignity for all women. Unfortunately, such voices tend to belong to women who are “outside the system.” Once women are in a legalized system, they are silenced. They can be coerced to give unnecessary pharmaceuticals to women and babies (oxytocin, erythromicin, vitamin K) and they become good corporate citizens. The real respect and admiration that comes from knowing that you are true to yourself is missing. Professional bodies do not protect the public, they protect the professionals.” ~ Gloria Lemay

Sunday at 5:14pm

 

J

ha ha ha ha ha ha ha! That’s plain funny.

Sunday at 5:22pm

 

Rebecca

Adding my thanks to Jill for hosting this dialogue, which has been very civil!

If anyone is still around and wants to take the next step into the legal weeds, I’ll add that midwives in a number of states have tried to defend themselves from prosecutions for unlicensed practice using “women’s autonomy” and a mother’s right to hire who she wants at her birth. Courts rejected this reasoning. See eg Bowland v. State (California), Hunter v. State (Maryland).

Sunday at 5:55pm

 

Valerie

‎”if the big push comes to michigan…”

Oh, please. You make it sound like Godzilla attacking Tokyo. I admire the courtesy and grace you have been shown by posters like Katie, Rebecca, and Susan. Unfortunately, I don’t feel so courteous.

I have been involved in midwifery politics/legalities for over thirty years. THIRTY YEARS. And what I used to see as correctable naïvete, I now see at little more than willful stupidity. I spent over twenty years as a homebirth midwife. I am an RN and have worked in labor & delivery. I am now an Illinois attorney. This isn’t exactly my first time at the rodeo. I have seen all these ridiculous “arguments” before. And while Carla and Gloria sell a lot of stuff, and certainly know a lot about self promotion, they don’t know shit about the law or how it works in the United States. You would do better to listen to the attorneys who, just in this thread, have given you far better advice than the refrigerator-magnet aphorisms you quoted above.

Oh — and about the legality of midwifery in Michigan? It isn’t. Legality isn’t somehow magically conferred just because the state is momentarily ignoring your practice and your presence. If you want to know the law (and if you still think you are practicing legally in Michigan, you clearly do NOT know the law) listen to lawyers, not Carla and Gloria.

Sunday at 6:03pm

 

The Unnecesarean

A reminder to keep it civil, please… Thanks.

Jen wrote: “I hope that was clear. I don’t know how else to say it.”

I get the gist of what you’re saying now. I wasn’t wanting to browbeat for details… just trying to figure out exactly how it plays out on paper.

Sunday at 6:07pm

 

J

Susan, are you a practicing lawyer? J, are you a practicing midwife?

Rebecca, thank you for your information thus far. While I still do not agree, I respect your point and will contact my lawyer in the morning regarding this important issue. Clarification is definitely needed.

Sunday at 6:14pm

 

The Unnecesarean

Rebecca wrote: “I’ll add that midwives in a number of states have tried to defend themselves from prosecutions for unlicensed practice using “women’s autonomy” and a mother’s right to hire who she wants at her birth. Courts rejected this reasoning. See eg Bowland v. State (California), Hunter v. State (Maryland).”

This is what freaks me out from a client/woman/consumer perspective. My belief is that a woman should be able to choose the birth attendant, if any, that she wants to work with. In states without licensing, adding licensing would add another choice for her— a licensed CPM and, ideally, VBAC wouldn’t be out of their scope of practice.

Listening to Rebecca makes me realize I’ve been in a bubble regarding the autonomy defense and out-of-hospital birth. I’ve focused so much on the coerced and court-ordered cesareans that I haven’t really delved into this. I have some serious reading to do.

Sunday at 6:20pm

 

The Unnecesarean

Jen, I’m following up on Rebecca’s posts, too. Thanks for your comments and civil debate. Feel free to touch base with anything interesting you find out this week.

Sunday at 6:23pm

 

J

‎”And while Carla and Gloria sell a lot of stuff, and certainly know a lot about self promotion, they don’t know shit about the law or how it works in the United States. You would do better to listen to the attorneys who, just in this thread, have given you far better advice than the refrigerator-magnet aphorisms you quoted above.”

AMEN valerie, amen amen amen and from reading about ALL the cases where midwives were and are prosecuted and lose not only their identity and profession as midwife, but a whole bag full of money, I highly doubt either midwife would aid in your defense $$$$ wise if YOU were on the receiving end of a prosecutor’s scope.

Sunday at 6:26pm

 

Jen

Valerie, I am reading about the case against Yvonne Cryns. She was a CPM, right?

Sunday at 6:48pm

 

Valerie

Yes. Yvonne was (and I believe, still is) a CPM.

Sunday at 6:57pm

 

Janet

‎@ Jill.

“This is what freaks me out from a client/woman/consumer perspective. My belief is that a woman should be able to choose the birth attendant, if any, that she wants to work with. In states without licensing, adding licensing would add another choice for her— a licensed CPM and, ideally, VBAC wouldn’t be out of their scope of practice.

Listening to Rebecca makes me realize I’ve been in a bubble regarding the autonomy defense and out-of-hospital birth. I’ve focused so much on the coerced and court-ordered cesareans that I haven’t really delved into this. I have some serious reading to do.”

YES! That’s exactly it! Look to other countries to see how women have lost the right to determine their own care, their own births, who they invite and whether or not they’re just being forced back into hospitals for caesareans.

In Australia midwives are being reported for simply taking on women seeking HBAC, before they’ve even birthed, without any adverse outcomes. Transferring, as noted above, is the time when hospital staff will maliciously report midwives despite them clearly acting safely in supporting necessary transfers, and even though the family involved are perfectly happy with the care and there has been no adverse outcomes.

I currently have a client seeking HBA2C with twins. There’s NO WAY she’d be allowed to birth in a hospital, no. way. But can she find midwives to take her on? There’s maybe two or three in our whole state who would because the others have now retired or joined the “collaborative” schemes which means they work for obstetricians now and HBAC is off the menu. HBAMC is considered practically criminally negligent.

The hospital she initially began going to early in her pregnancy have already scheduled her cs: 32 weeks. Yes, 32 weeks. In case TTTS occurs. Is there any sign of it? No. Does that matter? No. Will they support her to birth? No, it’s not allowed. Maybe a vba2c, maybe twins, (and a jolly big MAYBE indeed) but no way at all with both. Shouldn’t that be up to the woman to decide, we cry? Hell yes. And yet is it? Hell no.

Remember if the state doesn’t like your birth choice you also risk being reported and having your children removed. This is happening in Australia to homebirthing families now. The thing with one birth choice being removed is that all choices are then made null and void because they ain’t choices at all. Someone else’s choices presented to me are not my choices.

Putting this anti-birth, anti-woman, anti-midwifery campaign in an international context is essential. All those ACOGs, RANZCOGs and their fellow travellers are working together. So we need to be smart and watch them all.

I’ll be very pleased to hear your thoughts, Jill, after you’ve done the reading.

Sunday at 7:04pm

 

Janet

‎”I’ll add that midwives in a number of states have tried to defend themselves from …prosecutions for unlicensed practice using “women’s autonomy” and a mother’s right to hire who she wants at her birth. Courts rejected this reasoning. See eg Bowland v. State (California), Hunter v. State (Maryland).”

That so beautifully sums it up. Women have no right to autonomy and no right to decide who attends their births.

I don’t see this as a good thing in any way. No one is regulating my body, thanks.

Sunday at 7:08pm

 

Jen

Janet, that’s why I see the push as covering the certified midwife, not helping the birthing mothers.

I was reading this earlier: http://www.surveyusa.com/ArchivedArticles/suntimes0605.htm

Sunday at 7:18pm

 

Rebecca

Janet and Jill, I hope that my comment did not imply that I agree with those courts! The point was to show that women’s rights don’t confer a midwife with rights to practice legally in the eyes of US law.

I became a lawyer in order to defend women’s autonomy, even and especially when pregnant. Part of being good at that is understanding and recognizing the current law for what it is. I’m sensitive to the “master’s tools will never dismantle the master’s house” line of reasoning, but the law does and is regulating our bodies whether we like it or not.

Sunday at 7:21pm

 

Valerie

I agree, Rebecca. That was certainly one of the reasons I became a lawyer, and I have had the privilege of advising midwives and parents throughout the U.S. As you know, however, we don’t win cases by screaming about the “unfairness” of the law. What wins cases and *changes* law is understanding the law and why it is what it is. It is also critical to understand that the states have the right to regulate those who provide health care services to citizens. It is only by understanding what the law IS that we can begin to work to change it to what we want it to be.

Sunday at 7:40pm

 

Janet

Please don’t be patronising. Just as we don’t need to be obstetricians to understand caesareans, we don’t need to be lawyers to have a grasp of human rights and the law. No one’s “screaming” or talking about “unfairness” here. Birthing women can grasp just fine what rights they are accorded under any given law and which they are not. We can also see how it plays out in reality on our bodies.

Sunday at 7:45pm

 

Katherine M.

Perhaps, instead of pushing for licensing of midwives, we should be pushing for legality of midwives. Once licensing is brought into the picture, midwives will be required by the state to have malpractice insurance (because the state will be who licensed them, and who can ultimately be held liable if someone gets sue happy). Once insurance companies are involved, midwives will be told by the insurance companies whom the can and can not treat. They already do so to licensed midwives. Anyone with “high” blood pressure - risked out to OB. Anyone with a c-section -risked out to OB. Anyone with “high” sugars, the most times inconsequential and misdiagnosed, but dreaded GD - risked out to OB. Anyone spilling ketones during pregnancy (not considered “normal” by OBs) - risked out to OB. Anyone over a certain weight - risked out to OB. Anyone over a certain age - risked out to OB. Anyone whose baby is over a certain weight (by ultrasound) - risked out to OB. Anyone with twins - risked out to OB. Anyone with breech - risked out to OB. Anyone who goes over 40 weeks - risked out (and that group gets large based on the immovable, infallible wheel calculator based on an “average” of 28/14 day cycle/ovulate paradigm). Anyone with a previous preterm baby - risked out to OB. Do we see a trend here? I spill ketones during pregnancy. As a normal part of my pregnancies. I had a c-section. I’m considered very overweight and unhealthy by any doctor and OB who looks at me (they don’t listen to the fact that I used to weigh 400lbs and weigh half of that now). They assume, because I’m “fat” to their standards, that I have GD during pregnancy, and because I MUST refuse to take their stupid GD test (I had bariatric surgery, I’m not even allowed to LOOK at that kind of concentration of sugar, not to mention I am physically unable to ingest the amount of liquid in the time frame they want me to) they try to send me to diabetic nutritional counseling and tell me to eat more fruits and veggies and yadda yadda (which I am also not allowed to do because of the bariatric surgery…I must concentrate on protein, and any room that’s left over after consuming the amount of protein I must - which, btw, OBs and licensed midwives tell me to get 70grams of protein per day and yell at me when I have a LOT more than that, which is ridiculous seeing as I’m supposed to consume upwards of 100 grams NOT pregnant because of the surgery, is allowed to go to fruits n veggies). I’m now considered part of the “advanced maternal age” group. I birth babies over 9lbs. My cycle is 32 days long, ovulating on day 19. I had a preterm birth with the baby dying (exact reasons known, without a doubt). I had abdominal hernia surgery with mesh implanted. This, technically, makes me much more suited for birthing babies because I literally have abs of steel. The licensed midwives COULD not and WOULD not see me for any part of my pregnancy after my c-section (which they caused) because of their insurance policy dictating to them that I am “high risk”. Now…granted. I have a TON of things going on. Women with ONE thing that I’m dealing with get risked out and sent to OBs. But let’s be gracious and say we have a midwife who listens about say…a longer than “average” cycle and is willing to “fudge” the dates so it “looks” like an “average” cycle. What about women like me? With two or more things on the list of “high risk” things? We will continue to be thrown under the wheels of “LICENSURE for LEGALITY”. Get rid of the licensure caveat and I will stand behind the push. Legality for midwives. Women have brains. They can and should ask for references, ask about a midwife’s stats, ask about her education, yadda. They should OWN their births AND their pregnancies. Realize that, if something goes wrong, it was meant to go wrong, and it wouldn’t have mattered where you were, it still would have happened. There are no “what if’s” in life. You can’t turn back the clock and say “IF she’d been at the hospital x y z wouldn’t have happened”. No one can know that because she wasn’t there and it did happen. Where has common sense and the ability to think for ourselves and own our decisions gone? Oh wait. The Doctors took it from us over several generations of telling us that we “can’t” birth babies, we “need” drugs, we “need” hospitals “just in case”. You think they’re doing this for OUR good? Not on your life. They do it for THEIR pockets. As they always have and always will. I was told by doctors that I would NEVER be able to have a vaginal birth. They lied. I was told by doctors that I would NEVER be able to breast feed my child. They lied. I was told that my body was simply (!!!) and totally broken. THEY LIED. I had a vaginal birth with NO help from them. No problems. My midwife did nothing other than encourage me (HAH…nothing…her encouragement was invaluable and SUCH a difference from the other midwives from my sons birth). So it should be. It should not be able to be considered “practicing medicine” to take someone’s BP and show someone how to hear a heart beat. Period.

Sunday at 7:56pm

 

Katie B.

Which is exactly why I have such mixed feelings about this.

Frankly, I’m appalled by this statement: from J- “Those of you on this thread who don’t want regulation- just stick with your midwife. She doesn’t have to get licensed she can stay underground and you all can enjoy all the benefits of an unregulated health care provider: infection, dangerous practice and unscrupulous behavior.”

This is not the least bit civil, nor is it accurate.

I have had 2 homebirths and one homebirth transfer in 3 different states. The 2nd birth was in a state in which midwives were “allegal.” My midwife was not dirty, dangerous, or unscrupulous. To the contrary she made a homebirth possible for my baby who certainly would have not done well in a hospital setting.

How disheartening that someone has concerns—mine are more with the law as it exists, how it is carried out, and what happens after midwives are licensed, rather than licensing in general—or that someone doesn’t agree, and people just start mudslinging.

One of my biggest concerns has to do with how midwives are protected after being licensed when they actually do commit an error. Where I am now, a midwife in our state committed several grave errors which led to the death of a baby. She was completely protected by the midwifery board and by the state, and the family had no justice.

As it is, even though midwives have been legal here for quite some time, families are still reported to CPS for being homebirth transfers, for refusing eye-ointment for goodness sakes. But that is WITH legal-to-practice law.

I know midwives practicing here WITH a license who refuse to carry pitocin or oxygen.

Midwives in my area have become increasingly medical. Doctors in my area have become essentially ONLY surgeons. It’s a very difficult situation everywhere, but it is here even in a licensed state.

Sunday at 8:09pm

 

Melanie Hughes

Good point about risking out to OB’s Here in ontario Midwives are licensed and there are a lot to times that they are not allowed to attend home births here that they are everywhere else it seems..

VBAC’s pretty much have to go to the hospital, or transfer to an OB.

But there are VERY few midwives her to begin with…

Truthfully I think the C-section rate would be much lower and breastfeeding rates higher if there were more midwives!

I would take a midwife over an OB anyday. With an OB you are lucky if they spend more than 5min with you at a prenatal… Where as midwives spend up to an hour and provide education as well…

OB’s have a place - with high risk pregnancies(where there are REAL medical issues, not minor issues often overcome)…

Sunday at 8:14pm

 

Janet

I agree, Katie.

The least scrupulous operators with the highest infection rates and least accountable practitioners in birth are obstetricians in hospitals. The first “collaborative” midwife in my state is notorious for dumping women and keeping their money and then reporting them to child services. She has full protection from the law and is a collaborating buddy with the head of the AMA. How is that ok? She works within the guidelines the state has implemented and women have no come back.

How about someone does something about the dangers of obstetric practice which can be clearly demonstrated to be not in the best interests of women and babies?

Sunday at 8:27pm

 

Valerie

[email protected]: Is it really “patronizing” to suggest that a lawyer might have a bit more knowledge and understanding of case law and legal analysis than someone who is not a lawyer? If we “don’t need to be lawyers to have a grasp of human rights and the law,” why do we see defense fund websites and pleas for legal fees whenever a midwife is arrested? Why should she not just go to court and take of it herself? If “birthing women can grasp just fine what rights they are accorded under any given law…” why do we still see people using the word “alegal” as though it had any real legal meaning related to midwifery? Why on this very thread have we seen people arguing that the practice of midwifery is legal in Michigan?

You may not need to be an obstetrician to understand cesareans, but you do need to be one to DO a cesarean. And while I knew quite a bit about laws relating to midwifery on the numerous occasions I was a defendant (before I went to law school), I was mighty glad to have a lawyer defending me in court.

Sunday at 8:29pm

 

Janet

Your comments pretty much speak for themselves, Valerie. No need for me to respond to that.

Sunday at 8:31pm

 

Kenneth

[email protected] Please don’t be patronising. Just as we don’t need to be obstetricians to understand caesareans, we don’t need to be lawyers to have a grasp of human rights and the law. >>

My guess is that same people who discount the value of lawyers analyzing the law are the same people who think that midwives shouldn’t have to prove adequate training or minimal skills to attend births. But like it or not, EVERYWHERE in the US, states have the right to regulate professions where the presence of the right provider is the difference bewtwwn life and death. And any midwife who believes that her presence at a birth makes no difference in the outcome is in the WRONG profession.

Sunday at 9:20pm

 

Kenneth

[email protected] Janet, that’s why I see the push as covering the certified midwife, not helping the birthing mothers.>>

Personally, I think that laws which make sure that a birth attendant meets a minimum standard of training and skills benefit both midwives and ESPECIALLY birth parents. I don’t want any babies or mothers lost to incompetency, regardless of whether they are attended by doctors or midwives.

Sunday at 9:26pm

 

Katherine M.

How does licensing cause someone to “prove” their training? All it does is “prove” they can pass a test. Ultimately, NO one is able to change the outcome of anything. If a midwife is a midwife because she wants to “save” the baby or mother, or to “deliver” babies, she is in the wrong profession, she should be an obstetrician.

Sunday at 9:30pm

 

Janet

So why do hospitals have such poor outcomes, Kenneth? Everyone in there is licensed, registered, proven to be qualified. And yet their outcomes are appalling. What is licensing doing for women in that scenario? What is insurance doing for women in that scenario?

Sunday at 9:31pm

 

Kenneth

[email protected] M.  How does licensing cause someone to “prove” their training? All it does is “prove” they can pass a test. Ultimately, NO one is able to change the outcome of anything. If a midwife is a midwife because she wants to “save” the baby or mother, or to “deliver” babies, she is in the wrong profession, she should be an obstetrician.>>

Congratulations, you have eliminated the rationale for all licensure in all states. Now if only state legislatures and courts would adopt your reasoning, we’d have nothing to worry about. Other than kids and mothers dying at the hands of self-proclaimed midwives with next to no training. But they only have to worry about CIVILl liability in your framework and since midwifery isn’t a profession, there is no expectation of making any money anyway. Problem solved.

Sunday at 9:35pm

 

Kenneth

[email protected] So why do hospitals have such poor outcomes, Kenneth?>>

Licensure doesn’t guarantee that everyone is competent, it just provides a framework to make people accountable without criminally prosecuting them. I don’t have a high regard for the purely medical approach to birth but I have even less regard for midwives (and birth parents) who are closed-minded and arrogant enough to think that a doctor’s involvement is unnecessary under any circumstances. Part of the job of a midwife is to know when the situation is beyond her limits and scope of practice.

Sunday at 9:44pm

 

Katherine M.

No one is saying that doctors don’t have their place. Nor midwives. Who on here has been close-minded and arrogant?

Sunday at 10:02pm

 

Jen

Kenneth, I think you’re being a little over ambitious here. We absolutely need doctors. No one said otherwise.

Also, midwives don’t practice without others knowing about it. If someone tried to become a midwife without any training, the community would out them. You dont’ just “become” a traditional midwife. You go through the process just as you would if you were a CPM but you choose not to be tested by NARM. Is the midwife I trained with (15 years of experience, over 1500 catches, with no infant or maternal losses) less qualified than a fledgling midwife who just took her exam….JUST because she has “CPM” after her name?

Sunday at 10:23pm

 

Bonnie

But ….and this is so important to remember….childbirth is generally NOT a medical event, pregnancy is NOT a medical disease, but a natural condition.

Sunday at 10:42pm

 

Renee

So, I’ve done some reading and I guess I was misinformed when I believed this was a CNM vs. CPM thing. Looks like it’s more of a CPM vs. all other unlicensed midwives thing, right?

I did not know my CPM was practicing illegally (in Michigan……). She does have medications (as I mentioned before) so I guess I’m curious as to how she got them. She also does collaborate with physicians (kind of).

I’m going to go off topic here…

I am in a master’s program now for CNM, and my goal is to open a birth center with the option of homebirths available.

I knew it was not easy for a CNM to do homebirths, but I was willing to put in the work and fight for the cause b/c it’s an important one. From reading, it sounds like CPM is synonomous with “out of hospital midwife”. Does this mean the Push could make it even more difficult for CNM’s to practice in the home setting?

Also, is there a place for CNM’s in the Push for Midwives campaign? I love midwifery, and while I know a lot of the homebirthing momma’s don’t have the same regard for us (CNM’s)… I know there is a place for us in traditional midwifery.

Monday at 2:03am

 

Melanie

As a mom I think that we need to have BOTH in-hospital and in Home Midwives! They are lots of women who for whatever reason want/need to birth in the hospital. They should have an alternative to the OB in lower risk pregnancies. I think the OB’s should be left for consults when required and Truely “high risk” pregnancies. VBAC’s, twins, and women in generally good health should be seen be midwives if possible. It would cut the c-section rate and improve maternal outcomes… The insurance companies should be interested in pursuing safer births, not just money… Face it C-sections are big money for hospitals - and they are very dr freindly(no waiting around for the baby to come). But a 1 in 3 cs rate is not in anyones best interest…

Monday at 5:16am

 

Susan

In NJ, midwives are legal to practice, but unless you want to birth at home, there’s no alternative to a hospital. :(

Monday at 6:08am

 

The Unnecesarean

Melanie, I mostly agree with you. I would add that I also trust women to make their own decisions for their bodies, including seeking medical care from an obstetrician for a low-risk pregnancy if that’s what